Decrease Ventilator Associated Pneumonia

Decrease Ventilator Associated Pneumonia Patients on ventilator support are very prone to respiratory infections. These patients have no means or control over what enters their lungs or what does not. One prevalent infectious process that can occur in these patients is ventilator associated pneumonia (VAP), and affects many patients every year who require ventilator support. Ventilator associated pneumonia is a form of pneumonia, a lung infection, which occurs in mechanically ventilated patients. It develops at least 48 hours or more after the ventilator is utilized (Powers, 2006). Ventilator associated pneumonia is caused by bacterial organisms entering the patients lower respiratory tract usually by aspiration of oral pharyngeal secretions. The bacteria colonize within the lungs causing immune response or infection to occur (Powers, 2006). The development of this infection can lead to a decline in the patients outcome and increased healthcare cost to the patient as well as the health care facility (Mori, 2006). With all t hese problems VAP can produce it is important to the patient as well as healthcare providers to be able to find ways to reduce the development of VAP cases in patients. The purpose of this paper is to determine if routine oral care can decrease the incidence of ventilator associated pneumonia in mechanically ventilated patients. The picot question guiding this paper is what effect does routine oral care have on the incidence of ventilator associated pneumonia rates in mechanically ventilated patients. Background and Significance Ventilator associated pneumonia is a serious infection affecting both the patient, healthcare facility, and staff. It is the second most common healthcare-acquired infection (Koening, 2006). Incidence of VAP is estimated as high as 65% and it occurs in up to 28% of patients who have been on the ventilator 48 hours or longer (Powers, 2006). The mortality rate associated with VAP ranges from 12-50% (Sona et al, 2009). Studies on the mortality rates of VAP also show that patients who develop VAP have a 2.2 to 4.3 times higher risk of death compared to other mechanically ventilated patients who do not have pneumonia (Powers, 2006). A couple affects that VAP has upon the patient and healthcare facility are time of hospitalization and healthcare costs. Ventilator associated pneumonia causes the length of a hospital stay to increase significantly. It can increase the hospitalization time anywhere from four to nineteen days longer (Powers, 2006). This extra hospitalization can cause additional stress for the patient and their health. As the incidence of VAP causes longer hospitalizations to occur, patient and health care facility costs climb also. It is estimated that the average increase in hospital costs is around $57,000 per VAP occurrence (Powers, 2006). There are also increases to the hospital that occur due to increases in supplies used, staff that is utilized, and more medications used. Since VAP has such a negative impact upon patients and healthcare facilities many interventions have been tried to prevent the incidence of VAP. One intervention utilized is keeping the head of the patients bed raised to at least thirty degrees to prevent aspiration of bacteria in secretions. Another is sedation vacations which consists of interrupting the patients sedation medication until patient shows signs of alertness, to assess if patients can be weaned off the ventilator more quickly. Other notable interventions that have been utilized in the past and some in todays practice as well include: suctioning secretions, good aseptic techniques such as hand washing, and oral care (Pruitt Jacobs, 2006). Patients are continually developing VAP and having complications from the infection. If it is found that routine oral care, defined as teeth brushing with the use of an oral antimicrobial within this paper, can reduce the incidence of VAP in mechanically ventilated patients it could decrease length of hospital stay, keep costs due to incidence of VAP down for both patient and healthcare institution, as well as decrease mortality rates in these patients. Clinical Question Ventilator associated pneumonia occurs way too often in the hospital setting. It causes significant stress on the patients already problematic health status. The writer of this paper has observed many nurses who are vigilant in providing oral care to ventilated patients, but has also observed other nurses who forego oral care as if it not important and has no affects upon the patients health. This made the writer question what the actual effectiveness of oral care has upon reducing the incidence of ventilator associated pneumonia in mechanically ventilated patients. This issue is very relevant to nursing because the ultimate goal of a nurse is to help the patient have the best possible outcome. Trying to achieve the best possible outcome for the patient makes infection control is a very high priority for nurses. Patients who have infections are more prone to get other infections and require more nursing care and more time to recover from their illnesses. Although VAP will continue to occur in patients, and oral care is not a cure for ventilator associated pneumonia, there is valuable information included in research studies included within this paper that shows the incidence of VAP can be reduced in mechanically ventilated patients by implementing routine oral care. Empirical Review 1 The purpose of the first study, conducted by Sona et al, 2005 was to determine the effect of a routine oral care protocol upon incidence of ventilator-associated pneumonia. The research design was a quantitative, experiment, quasi-experimental study which utilized a non-equivalent control group before and after the design. The study had no conceptual framework stated by the researchers. Within the study, the variables of significance to the clinical question being looked at were the routine oral care protocol and the ventilator-associated pneumonia rates. The independent variable of new oral care protocol was defined as the mechanical cleansing of the teeth or gums to remove plaque with a tooth brush and the application of an oral antimicrobial. The study went on to further discuss the protocol as brushing the teeth for one to two minutes with a regular toothbrush and then applying .12% chlorahexidine to all oral surfaces every twelve hours. The dependent variable was the ventilator associated pneumonia rates. It was defined as a common hospital acquired infection and is the leading cause of death in ICU patients who are ventilator dependent. Ventilator associated pneumonia rates were measured using the National Nosocomial Infections Surveillance System (NNIS) criteria.The reliability nor the validity of this instrument was addressed within the study. Another variable that was studied was length of stay. This was just measured by the number of days that the patient spent within the ICU after a ventilator associated pneumonia infection occurred (Sona et al., 2009). This study took place at Barnes Jewish Hospital on a 24 bed intensive care unit (Sona et al., 2009). The study focused particularly on patients that were admitted to the surgical intensive care unit (SICU) whom required mechanical ventilation. The subjects consisted of all patients who had mechanical ventilation between June 1, 2003 and May 31, 2005. Subjects were chosen using non-probability convenience sampling. The pre-intervention was implemented for patients that were admitted between June 1, 2003 and May 31, 2005. The size of this sample was 777 patients. The pre-intervention phase consisted of standard care the nurse provided to the patients, no changes were provided during this time; only observation took place. One month before the end of the pre-intervention phase all nursing staff working on the SICU were debriefed and educated on the aims of the study as well as the new routine oral care protocol by two clinical nurse specialists and a nurse educator. This was to help pre vent discrepancies in the intervention. During the post intervention phase of the study which took place between June 2004 until May 2005 the sample size consisted of 871 patients who were all nil per os (NPO) (Sona et al., 2009) On June 1, 2004 the new routine oral care protocol was implemented (Sona et al., 2009). The intervention/protocol consisted of the nurse brushing the teeth of the patient for one to two minutes with a regular toothbrush, rinsing the mouth with water and suctioning it out, and then using 15 mL of .12% chlorahexidine to cleanse the mouth. The intervention was repeated every 12 hours by the registered nursing staff. Compliance of the protocol was estimated to be around 90% and the implementation was carried out for 12 months before results were analyzed(Sona et al., 2009). For this study the level of significance was expressed using p-values. A p value of less than .05 was considered significant (Sona et al., 2009). For the data analysis, two statistical tests were used: The Mantel-Haesnel Chi Squared . After the analysis of data, it was determined that p=.04 showing that the routine oral care protocol did cause a significant reduction in the ventilator-associated pneumonia rates within the subjects studied. The pre-intervention rate for VAP was 5.2 infection per 1000 ventilator days while post-intervention rate for VAP showed 2.4 infections per 1000 ventilator days (Sona et al., 2009). Other statistics for the study showed the patients number of days the patient was on ventilator was decreased(Sona et al., 2009). From the statistical analysis within the study, the researchers derived certain findings and conclusions (Sona et al., 2009). One of the findings was that the post intervention group had trends toward shorter time on the ventilator, as well as length of hospital stay. The main finding within the study found that when the routine oral care protocol was being utilized, the rates of ventilator-associated pneumonia were significantly decreased. The researcher makes it a point to state that although the finding suggests that the implementation of the protocol reduces rate of VAP this cannot be proven (Sona et al., 2009). This study is a nonrandomized controlled trial. The quality of this evidence was convincing and significant. It was a consistent study and it is considered to be of Level II quality. Certain extraneous variables that could have had an effect upon the outcome of the study, as identified by the student, could have been the condition the patient was in before the ICU admission, any pre-existing conditions that could alter health and increase the risk of infection, and the nurses attitude toward performing oral care. Although the study was a strong and consistent one, it did have both strengths and weaknesses. There were no strengths identified by the researchers. However, the student did identify some strengths within this study. One of the first strengths was the education that was given to the nursing staff prior to the implementation of the protocol. This helped the study to be more valid by increasing the continuity of the care and way the nurses performed the protocol. The other strength of the study was the design being a quasi-experimental. This is because quasi-experimental studies usually can be generalized to the population that is being studied. Weaknesses that were addressed within the study by the researchers was that the researchers themselves did not evaluate the teeth brushing portion of the intervention to make sure that the nurses were being consistent in the way they did it, and if the nurses performed it for the correct amount of time (Sona et al., 2009). This resulted in the lack of control over nursing techniques. Another weakness of the study recognized by the researcher was the study did not take into account the change in the patient population over the duration of the study (Sona et al., 2009). Some weaknesses the student identified within this study was that the study was very susceptible to bias because no blinding or masking was used within this study. Everyone knew what was occurring and this could have had the researchers looking as if the intervention helped more than it actually did. Within the study the researcher did not address if the study could be generalized. However, the writer of the paper believes that this study can be generalized. The intervention is a very simple one. Most cultures have no problems with utilizing oral care. Also, most hospitals have intensive care units and/or ventilator dependent patients which were the population within the study. This intervention within the study does not have a lot of risks. The only risks mentioned were possible tooth staining from the antimicrobial and poor taste (Sona et al., 2009). Also, this intervention is very feasible. To implement oral care there is no special training needed, although education should be provided. The oral care routine is a relatively quick intervention that takes no more than 5 minutes to implement, which would allow nurses with busy schedules to still be able to perform the intervention. Also, this intervention is very low cost compared to the cost of ventilator associated pneumonia c ases. Therefore, the cost-benefit ratio would be a great benefit to health-care facilities. This study suggests that oral care can be very effective in decreasing the incidence of ventilator-associated pneumonia rates. Although a very valid study, one study is not enough evidence to implement a new protocol into a nurses practice. One must look for more studies and literature to support the finding in order to attempt to implement it into practice. The next study that was appraised by the writer of this paper seems to support the findings that were found in this study. Empirical Review 2 The next study examined by the writer of this paper was a research study conducted by Mori et al.,2005. The purpose of the study was to determine if oral care of mechanically ventilated patients contributed to the prevention and reduction of the incidence of ventilator associated pneumonia (Mori et al., 2005). The research design utilized for this study was a quantitative, experimental, quasi-experimental which used a non-equivalent before and after approach. Within the study the researcher did not state any theoretical framework to guide the study. The study was not randomized, and used a non-probability convenience sample method (Mori et al., 2005). The research study took place on a medical/surgical intensive care unit in an urban university hospital which was not named by the researcher (Mori et al., 2005). The population of interest was ventilator dependent patients with tracheal intubation. Since subjects were chosen by convenience sampling, they were chosen as they became available on the unit. Inclusion criteria for subjects were that they must have been receiving mechanical ventilation and have tracheal intubation. Exclusion criteria for the study were patients whose conditions contraindicated oral care, patients with severe bleeding tendencies, or patients with iodine allergies. The sample for the oral care group was patients admitted to the intensive care unit between January 1997 and December 2002, and consisted of 1,248 patients. The sample for the non-oral care group, or the control, was patients admitted during January of 1995 until December of 1996; this sample size was 414 subjects (Mori et al., 2005) For this study, the independent variable was the oral care being delivered (Mori et al., 2005). This variable was defined as cleansing of the oral cavity three times a day by nursing employees following the specified new protocol. The protocol was that the nurse would check the patients vital signs and then do oral suctioning, followed by positioning the patients head to the side to prevent asphyxiation and determine the condition of the oral mucosa. After this the nurse would clean the mouth with a 20-fold diluted solution of providone-iodine gargle (antimicrobial). Then the use of a standard toothbrush was used to brush the teeth; the patients mouth was rinsed with water. Directly following the brushing and rinsing, the providone-iodine was utilized again by swabbing the mouth and teeth. Finally, oral suctioning was done one final time. The dependent variable in the study was the incidence of ventilator associated pneumonia. This variable was defined as a hospital-acquired pneumoni a that becomes present after 48 hours of the patient being mechanically ventilated. Ventilator associated pneumonia was suspected if patch infiltrates were present upon the patients chest x-ray and two of the following were present: a temperature of 100.4 degrees Fahrenheit, white blood cell count of 10,000 m3 or higher, or purulent respiratory secretions were observed. A definite diagnosis of ventilator associated pneumonia, which was used for evidence of the incidence in this study, was determined by trancheobronchial secretion cultures showing a result of 1+ or more. Other variables were duration of hospitalization defined as length of stay measured by the number of days and the causative agent of the pneumonia identified by bacterial cultures (Mori et al., 2005). Reliability and Validity of the cultures and radiography used to measure if ventilator associated pneumonia was present and causative agent were not addressed within the study by the researcher, so the validity is unkno wn.

The Potential of Gene Therapy to Cure Diabetes Essay -- Biology Medica

The Potential of Gene Therapy to Cure Diabetes Abstract Gene therapy treats and prevents a disease by introducing a vector of genetic material into certain cells to alter the function or ability of a gene. The promise of gene therapy as a cure for diabetes has been considered ever since this new technology emerged into the clinical and research sphere. Although such methods have yet to undergo human clinical tests, gene therapy holds much potential to bring a radical new way of treating autoimmune diseases such as diabetes. By targeting certain genes that control the insulin and ?-cell production in the pancreas, gene therapy will someday fulfill its potential to cure the disease that is the number one cause of heart disease in the United States. This paper will explore the potential protocols and products that can be used to treat Type I Diabetes. Diabetes is an autoimmune disease that has affected more than 140 million people in the world. This disease, results from the attack of the killer T-cells of the immune system upon the ?-cells in the pancreas that produces insulin. (Lin et al., 2001). Until recently, this disease could only be treated with daily insulin injections and adherence to a strict, low glucose diet. With more than ninety percent of diabetics at risk for future complications like heart disease, blindness, and renal failure, diabetes has developed into more than just a medical issue. Diabetes is also becoming largely an emotional and economic issue. Victims of this disease have no choice but to adjust their lives around the only object that could change their lives?a daily injection that may cost 50% of the annual income in developing countries and up to 600% in non-developed countries. New technology th... ...ne Therapy, (10), 875-889. Grey, S.T., et al. (1999). Adenovirus-mediated gene transfer of the anti-apoptotic protein A20 in rodent islets inhibits IL-1ï ¿ ½-induced NO release. Transplantation Proceedings, (31),789. Lin, Andrew, Cathy Huang, and Kendrick Ong. (2001). Type I AutoImmune Diabetes. Diabetes & Gene Therapy. July 21, 2005: http://dragon.zoo.utoronto.ca/~jlm2001/J01T0301B/index.html Nitta, Y., et al. (1998). Systemic Delivery of Interleukin 10 by Intramuscular Injection of Expression Plasmid DNA Prevents Autoimmune Diabetes in Nonobese Diabetic Mice. Human Gene Therapy, (9), 1701-1707. Rudolph, Frederick B., et al. (1996). Biotechnology: Science, Engineering, and Ethical Challenges for the 21st Century. Washington, D.C.: Joseph Henry P. Thule, P.M. and Liu, J.M. (2000). Regulated hepatic insulin gene therapy of STZ-diabetic rats. Gene Therapy 7: 1744-1752.

Indian Cheese Industry

Market Analysis: The Indian Cheese Industry| September 18 2010 | This Report gives a market study of the Indian cheese industry, key players and their market shares and strategies. It contains a study about the scope for growth in this sector and a SWOT analysis of the same. | Indian Cheese Industry| INDEX Sr. No| Topic| Page No. | 1. | Overview| 1| 2. | Market Size and Growth| 1| 3. | Key Players| 1| 4. | Analysis of Individual Players4. 1. Gujarat Cooperative Milk Marketing Federation (GCMMF) 4. 2. Britannia New Zealand Foods Private Ltd. Industries Limited (BNZF)4. . Dabon International Private Limited4. 4. Imported Cheese Market4. 5. Regional Players| 33781011| 5. | SWOT Analysis of the Indian cheese industry5. 1. Strengths5. 2. Weaknesses5. 3. Opportunities5. 4. Threats| 1212131314| 6. | Market Segmentation| 14| 7. | Trends in the Indian cheese market| 15| 8. | Observations| 15| 9. | Summary| 16| 1o. | Key Government Contacts| 17| 11. | References| 18| The Indian cheese Industry 1. Overview Except for the popular Indian variety of cottage cheese-Paneer, India is not traditionally a ‘cheese nation'.But, with the growing saturation of cheese consumption in the West and encouraging successes in other ‘non-cheese' Asian countries like Japan and China; overseas cheese producers are eyeing the Indian market for its huge promise. The organised cheese industry in India is at best in its nascent stage, accounting for less than 1% of total dairy production and largely limited to urban consumption. Though cheese was first marketed in India under the brand name ‘Amul', from the popular Amul butter stable in the late 1970s, it attained an identity of its own only as late as 1990s. 2.Market Size and Growth rate The organized cheese industry in the country as of 2006, is valued at Rs 250 crore (US$ 50 million), with a volume of more than 8000 tonnes. The industry growth rate is estimated at about 10%-12% per year in terms of volume and 16%-17% per year in value terms. Current household cheese penetration is 5%, with about 50% of consumption being limited to cities. Mumbai and Delhi together capture half of the cheese market. Within cheese products, around 60% of the market is dominated by processed cheese, 30% by cheese spreads and the remaining 10% by flavoured and specialty cheese. .Key players The Indian cheese market is dominated by Gujarat Cooperative Milk Marketing Federation that uses the brand name Amul and Britannia New Zealand Foods Pvt. Limited, using the brand name ‘Britannia MilkMan'. Amul is way ahead of competition and owns about 60% of the market. Britannia has about a 25% share. Other players are Dabon International Private Limited, a wholly owned subsidiary of the French dairy company Bongrain S. A and other regional brands like Mother Dairy and Vijaya. These companies have a 10% market share.The remainder 5% of the market is taken by imported cheese brands, retailed in specialty stores. Table 1: The Indian Cheese Market Key players Brand(s)| Estimated Share of Market (%)| Amul| 60| Britannia MilkMan| 25| Le Bon, Regional brands e. g. Mother Dairy, Vijaya| 10| Imported brands e. g. Kraft, Laughing Cow| 5| Fig 1: Pie chart showing % market share of the major players 4. Analysis of individual players: 4. 1. Gujarat Cooperative Milk Marketing Federation (GCMMF) 4. 1. 1. Company Profile: Amul is the leading brand name for products produced and marketed by the Gujarat Cooperative Milk Marketing Federation (GCMMF).GCMMF is an apex body of milk co-operatives in Gujarat and heralded the ‘white revolution' in India that turned the country from having a milk-deficit to the largest milk producer in the world. GCMMF also markets milk powder and dairy whiteners under the Amulya and Sagar brand names. Amul is the oldest and the most established dairy brand in the country, with its first product, Amul butter, being marketed since 1946. Today, the company has its roots deep in the dairy market and is increasingly focusing on the value added segment that includes health drinks, cheese and dairy based desserts.Turnover in 2005-2006 was US$ 850 million with a year-on-year growth of 29%. 4. 1. 2. Cheese Perspective: Amul brands and markets itself as the largest vegetarian cheese producer in the world since all its cheese varieties are made from microbial rather than animal rennet. This immediately makes the brand's' cheese products favourable in a country with the most vegetarians in the world. Also, it sources its cheese form buffalo milk, which is popular in India. 4. 1. 3: Products The various products produced by Amul are shown in the table below.Table 2: Cheese Products by Amuls Cheese Product| Description| Maximum Retail Price| Amul Pasteurised Processed Cheese| A cheddar cheese| 400g: Rs 86 1 kg: Rs 163| Amul Cheese Spreads (in three flavours)| Combination of Cheddar and soft cheese. | 200g: Rs 32| Amul Emmental Cheese| Specialty Swiss cheese which is sweet, dry and ha s a hazelnut aroma| 400g: Rs120| Amul Pizza Mozzarella Cheese| For use in pizzas| 200g: Rs 43| Gouda Cheese| Specialty Dutch cheese. Manufactured under a Swiss technical collaboration in the North Eastern Himalayan state of Sikkim.   | Amul chiplets| Individually packed single serve cheese cubes| 200g: Rs 50| Amul Malai Paneer| Indian cottage cheese| 100g: Rs14200g: Rs 26 1kg: Rs 115| Amul cheese slices| For sandwiched and burgers| 100g: Rs27 200g: Rs52| Amul Pizza| Frozen pizzas| Rs 30| Its cheese business grew at 18% in 2005-2006. GCMMF exports cheese to the tune of 600 tons, making it the largest cheese exporter in the country. The export market includes the Middle East, Singapore, Hong Kong, and the United States of America; countries that have a large Indian population, and the neighbouring countries of Sri Lanka, Bhutan and Nepal.A very rewarding strategy for Amul has been to also enter the cheese dependent food product category. It produces over 300,000 frozen pizzas (using mozzarella cheese), priced at a mere Rs 30 apiece. This has provided strong competition to international brands in the market which traditionally only sell pizzas at their retail outlets and at much higher prices. 4. 1. 4. Strategy: As its product lists, GCMMF has capitalized on the value added segment with a wide range of Amul cheeses. The Amul brand represents ‘value for money' to the Indian consumer and its cheese portfolio is competitively priced and of assured quality.The company has been aggressively marketing its cheese products, to the extent of even moving away from its umbrella brand strategy and introducing a new mascot, the Amul Cheese Boy. When low cost pizzas were introduced, GCMMF adopted an innovative and successful strategy of increasing sales of an elitist product (cheese) by reducing the price of another elitist product (pizzas). Especially since 2005, the company has focused on expanding its already strong distribution network to smaller cities as cheese d emand has rapidly expanded beyond the large metros. . 2. Britannia New Zealand Foods Private Ltd. Industries Limited (BNZF) 4. 2. 1. Company Profile: BNZF is a joint venture company founded in 2002 by Britannia Industries Limited (BIL) and Fonterra Co-operative Group of New Zealand. The company focuses entirely on the dairy business, with cheese being its flagship product. The other products it sells are dairy whiteners, butter, ghee (Indian clarified butter) and a malt drink- Anlene. All products are marketed under the ‘Britannia MilkMan' brand.BIL (known as Britannia Biscuit company until 1979) has essentially been a ‘biscuit company', that had humble beginnings in Calcutta in 1892. Its big break came during World War II when the Indian Government contracted it to supply biscuits to the armed forces and since then it became a market leader in the biscuit segment. In 1954, the company also began producing and selling bread and it was as late as 1997, that it entered the dairy industry. In 2002, Forbes Global rated BIL as one of the top 200 small companies of the world and as a strong and trusted brand in India.The Wadia Group of India along with Groupe Danone of France are equal shareholders in ABIL, UK which is a major shareholder in Britannia Industries Limited. Fonterra Cooperative Group is New Zealand's largest company and amongst the ten largest dairy companies in the world. The dairy expertise and global experience for the Joint Venture comes from Fonterra Cooperative while Britannia's contribution is its brand name, large distribution network and the understanding of the Indian market. Like BIL, BNZF also comes under the umbrella of the Wadia Group of companies.Its turnover in 2005-2006 is US$ 24 million with about 50% coming from processed cheese, 30% from the dairy whitener and the remaining 20% from butter and ghee sales. 4. 2. 2. Cheese Perspective: BNZF only sells in the processed cheese segment and has five variations of processed che ese in the market, besides a cheese dip product. Over half of the company's revenues come from the processed cheese segment. BNZF cheese is priced at a premium in the market; one reason being that the cheese is sourced from cow's milk (unlike Amul that sources its cheese from buffalo milk). . 2. 3. Products: Cheese cubes, Cheese singles (regular and Slim variants), Britannia Milkman Malai Chaska- a soft, fresh and creamy ‘dairy spread,’ which has a mild, tangy taste, Britannia cheese spread in different flavours like Masala Herbs, Spicy Cilantro, Peppy Pepper etc. , and Pizza cheese. 4. 2. 4. Strategy: Rather than focusing on competitive pricing, BNZF has adopted a ‘three-pronged strategy’ of: Freshness (lower pipeline stock), Availability (improve distribution network) and Visibility (more shelf space at modern trade).At present, cheese products, contribute to around 50 % of the Rs 120 crore turnover of the dairy product company (which markets its products under the brand name Britannia Milkman) while its Diary whitener contributes to 30% and butter and ghee together account for 20 %. 4. 3. Dabon International Private Limited 4. 3. 1. Company profile: Dabon International Private Limited is wholly owned by the French dairy major Bongrain SA. The company began as a joint venture with Dabur India in 1996, but in June 2005, Dabur exited from the business.The company said that they had decided to exit because cheese and milk products were a ‘non-core' business for them. Dabon is the only international cheese company to produce and sell cheese in the country, using the brand name Le Bon. It has a state of the art facility in Noida, near Delhi. Despite having made losses, the company has been in an expansion mode, offering a selection of processed cheese products. Adapting to Indian tastes, it has also recently introduced in Delhi and Mumbai, Indian cottage cheese with the brand name ‘Le Paneer'. Dabon markets its cheese to both the retail and institutional sector. . 3. 2. Cheese Perspective: Dabon focuses on the processed cheese segment, catering to both the retail and institutional markets. In the former, it has been targeting families and children (like the other brands) and in the latter category, it has standard and customized products for fast food chains, hotels, flight caterers and restaurants. Some of its institutional clients include Domino Pizza, Papa John’s Pizza, Oberoi Flight Services and the Ambassador.Besides drawing on the international cheese portfolio of its parent Bongrain SA, Dabon has realized that to compete, it has to cater to ethnic tastes. Le Paneer', the Indian cottage cheese variety was recently introduced as a brand in Delhi and Mumbai. 4. 3. 3. Products Table 3: Dabon Products for the Retail Sector Cheese Product| Description| Maximum Retail Price| Le Bon Creamy n Sancky Cheese Portions| A ready to eat snack, targeted at children. | 6 portion pack – 114g – Rs 36 Single portion – 19g – Rs 6| Le Bon creamy Cheese spread (Bottled spread in two flavours: Plain and Black pepper)| Marketed as a low fat butter substitute, with 60% less fat than butter. Both flavours: 200g-Rs 45| Le Bon Tasty Cheese Slices ( Two flavours: Plain and Black pepper)| A ready to eat snack, targeted at children| Plain: 170g- Rs 57 Black Pepper: 170g- Rs 59| Le Bon Grate n Garnish Cheese| A mild processed cheese for grating and garnishing. | Comes in 4 different pack sizes: 100g – Rs 24, 200g – Rs 46, 400g – Rs 86, 1Kg – Rs 185| Le Bon Paneer| Indian Cottage cheese| 200g: Rs 26 400g: Rs 50| Table 4: Dabon Products for the Institutional Sector Cheese Product| Description| Creamy n Sancky Cheese Portions| Suitable for in-flight meals, mini-bars and breakfast buffets.Available in 19g portions| Creamy Cheese spread (Two flavours: Plain and Black pepper)| Suitable for Italian food, baked dishes and dips| Individually wrapped che ese Slices (Two flavours: Plain and Black pepper)| For burgers and sandwiches. Available in 17g portions| Grate n Garnish Cheese| An all-purpose mild processed cheese for grating and garnishing. Available in 1kg blocks| Cheddar Processed Cheese| All-purpose cheddar processed cheese. Available in 1kg blocks| Le Bon Paneer| Indian Cottage cheese. Available in 200g and 400g packets| 4. 3. 6. Strategy:Dabon has played it safe in the Indian market so far, confining production and sales to the popular processed cheese and Paneer segment. It capitalizes on the fact that it uses international world class production techniques with a focus on quality and hygiene. Bongrain SA obviously believes in the potential for cheese in India, increasing its investment in the country despite having its joint venture partner Dabur pull out. 4. 4. 1. Imported cheese Market When the Indian government removed quantitative restrictions on consumer products in 2001, it was expected that imported products would flood the market and pose a threat to local brands.International cheese companies have established agents to market their products and enter the Indian market. The three main importers are: Bel Fromageries  which introduced its Laughing Cow brand in 2001 and more recently, Kiri cream cheese. Kraft cheese is presently available only in specialty imported goods stores. However, the company is planning to enter the Indian market and its strategy is to have an extensive reach into small retail outlets in the country. The company also aims at a presence by introducing ‘affordable products with the right attributes that meet local consumer needs'.Boursin a large French cheese maker announced its entry as an importer of cheese into the Indian market in November 2006. Boursin will be traded in the country by RRO, which has a tie up with Unilever for marketing and distribution. RRO is an established importer of international branded consumer food items. Boursin is a 100% Vegetarian Cheese since it is made without animal rennet. The product is available in four varieties in the country: Boursin Plain, Bourisn Garlic and Fine herbs, Boursin Pepper, and Boursin Shallot and Chives.Boursin Cheese is available at several leading food outlets in the country. 4. 5. 1. Regional Players: Encouraged by the success of Amul, many state dairy cooperatives have entered the cheese segment. These cooperatives have capitalized on their existing brand strengths to capture a sizeable market share in their region. Prominent regional players are: Table 5: Regional Players in the Indian Cheese Market Company| Brand ;amp; Regions| Cheese Products| Other Products|Mother Dairy India Limited (wholly owned by National Dairy Development Board)| Mother Dairy (North India, Mumbai and Calcutta| Individually wrapped slices, Cheese spread, Cheese cubes and Paneer| Liquid Milk, Yogurt, Ice creams, Dairy Whiteners, Butter, Frozen vegetables, Fresh fruits and vegetables, Vegetable oils and Fruit juices| Milkfed (Punjab State Cooperative Milk Producers Federation)| Verka (North India, Mumbai and Calcutta)| Cheese spread, Processed cheddar cheese, Natural cheddar cheese, Cheese singles and Paneer| Flavoured milk, Lassi, Yogurt, Butter, Ghee, Milk powders, Malted drink, Ice-creams, Milk based Indian sweets| Andhra Pradesh Dairy Development Cooperation Federation (APDDCF)| Vijaya (Predominantly South India based)| Processed cheese| Sterilized Flavoured Milk, Paneer, Indian sweets and Buttermilk| Of the above listed players, Mother Dairy is the largest, with aggressive growth plans in the cheese business.The company's strategy is to focus on the large children’s segment, with two successful marketing campaigns in 2006 – aimed at the child consumer, and to have a better relationship with retailers. As part of its strategy to increase its national presence, Mother Dairy also plans to improve its distribution network and increase the shelf life of its cheese – so as to increase its reach in the country. Mother Dairy's sales for cheese are increasing at about 30-40% a year. Two other state cooperatives that produce and market cheese are the southern states of Karnataka (Nandini brand) and Tamil Nadu (Aavin brand). These two brands though, essentially maintain a state presence rather than a regional one. 5. SWOT Analysis of Indian cheese industryFor developing a sound strategic plan for the cheese industry and mainly for the marketing and brand recognition, first a detailed analysis is required to be done. For this reason, a SWOT analysis of the same is done as shown below: 5. 1. Strengths: The Demand for cheese is ever increasing with change in the consumption pattern of consumers. In the mass consumption category, Indian consumers are more ready to buy off the shelf. Paneer, which all the major cheese producers are marketing as a branded product, was traditionally homemade. Secondly, with greater international exposure, rising incomes and brand affiliation; the demand for niche cheese products has increased.Amul was an early mover in capitalizing on the demand for specialized cheeses like Gouda and Emmental. The profit margins for companies are  quiet reasonable since competition is not very fierce like in the Indian telecom sector. The availability  of raw material is abundant since India is the world’s largest milk producer, accounting for more than 13% of world’s total milk production. India has abundant technical  manpower which can be professionally-trained; a technical human resource pool is available. 5. 2. Weaknesses: One of the biggest problems in the marketing of cheese is the lack of existing infrastructure, especially cold chains from the producer to the consumer.Existing players, especially Amul that also uses such facilities for its other dairy products like milk, already has a fairly well established national network. However, new entrants, including importers need to make extra in frastructural investments. This can be quite daunting for companies that are making a market entry into the dairy and cheese industry, particularly with limited existing knowledge of current distribution issues. The lack of cold storage facilities cause the biggest problems to regional players who are trying to gain a national presence. They neither have existing infrastructure nor the financial muscle of international companies. To improve logistical issues, some regional players, like Mother Dairy are positioning their plants in different geographical regions.Many regional cheese brands are currently not able to retail nationwide because of the limited shelf life of their cheese products. For example, Mother Dairy, a subsidiary of the National Dairy Development Board and a hugely successful retailer has confined most of its sales to the northern belt. Its reason- the shelf like of most of its dairy products including cheese is only about 10 days. . India being the second largest c ountry in the world and a land of distances, most regional producers do not have the advanced packaging, processing and distribution technology for geographical expansion 5. 3. Opportunities: The increasing incomes of the people due to a strong growth in the GDP allow huge potential for growth. The cheese industry is growing at almost 20% per year.The explosion of retailing in India will probably have a significant impact on the cheese industry; it will provide the cheese manufacturing companies with better distribution networks which will result in an increase in sales. There is a phenomenal scope for innovations in product development, packaging and presentation. I. e. Indianization of cheese by coming up with various different flavours suited to Indian tastes. E. g. Dabon, in acknowledgement of customer preferences for indigenous cheese, has customized their portfolio to include paneer. Efforts to exploit export potential are already on. Amul is exporting to Bangladesh, Sri Lanka , Nigeria, and the Middle East. Following the new GATT treaty, opportunities will increase tremendously for the export  of agro-products in general and dairy products in particular for the local players.There is scope form improvement in Food Technology to increase the shelf life of cheese and thus increase the nationwide presence of cheese products. 5. 4. Threats: Importing cheese, especially for mass consumption faces two main stumbling blocks:   i) High costs: Added to the high cost of importing cheese, importers often also have to invest substantially in a distribution network due to the lack of cold chains. Indian consumers are price sensitive and importers find it difficult competing against local, better priced brands, which are also in synch with the local palate. ii) Inordinate time lag in supplies: Due to logistics and the duration of the import process, replenishing stock takes at least a couple of months, making it difficult for importers to cater rapidly to demand v ariations.Competition among Sellers: The two pronged strategy that sellers will follow in the next few years is i) To increase the size of the market through greater awareness, and ii) To increase availability of cheese products to the expanded market. The Amul and Britannia brands have the strongest national dairy brand identity. To compete with these established brands and gain national presence, other cheese retailers will resort to heavy marketing. Cheese advertising budgets alone are likely to be around 2%-4% of total revenues. Advertising strategies could include, for e. g. cross selling with complementary food products and offering free cheese tasting sessions. In the past couple of years, for example, Mother Dairy has already been pursuing aggressive advertising strategies.One successful promotion in Delhi and Mumbai was the â€Å"Cheese khao superhero ban jao† (Eat Cheese to become a Superhero) event, where kids buying cheese at retail outlets were invited for a phot o- op – dressed as superheroes with a framed photograph presented to them. Another helped the company bond better with its retailers. In November 2005, retailers in Delhi displayed banners proclaiming, â€Å"Cheese ke saath bees ki cheez† (Buy Cheese and get Rs. 20 worth of freebies), a proposal where, if a consumer bought Mother Dairy cheese, the retailer would offer her free purchases worth Rs 20 from the store. Both these innovative campaigns were hugely successful in brand awareness and sales.Conclusion: The study of this  SWOT  analysis shows that the ‘strengths’ and ‘opportunities’ far outweigh ‘weaknesses’ and ‘threats’. Strengths and opportunities are fundamental and weaknesses and threats are transitory. Any investment idea can do well only when you have three essential ingredients: entrepreneurship (the ability to take risks), innovative approach (in product lines and marketing) and values (of quality/et hics). 5. Market Segmentation: In terms of market segmentation, all the Indian cheese brands cater primarily to the retail sector. On the other hand, Dabon International Private Limited and Bel Fromageries have a retail and institutional client focus.The insitutional sector, comprising fast food chains, restaurants, in-flight caterers and hotels also source their cheese from private dairy companies like Dynamix Dairy. Geographically, cheese is produced and marketed for domestic consumption. Amul Malai Paneer is only cheese product exported to the Middle East, Singapore and North America. Paneer is targeted at the large Non Resident Indian (NRI) population in these countries. 6. Trends in the Indian cheese market 7. 1. Production patterns The state cooperatives that market cheese like Amul, Mother Dairy and Verka have their own production plants and source milk from their cooperatives. Among international cheese companies, only Dabon Private Limited also produces cheese in the countr y, having its own plant in Noida, near Delhi.The only significant private player, Britannia, does not make its own cheese but has it produced by the Maharashtra based private dairy company Dynamix Dairy Private Limited (which has a technical collaboration with Schreiber Cheese, USA). Bel Fromageries, the global French company that sells Laughing Cow and Kiri varieties of cheese in India, imports cheese into the country through its agent, Rai and Sons, Delhi. 7. 2. Consumption patterns: Cheese consumption continues to be an urban phenomenon, with processed cheese and cheese spreads accounting for about 80% of the total cheese consumption. Also, cheese is mostly consumed by children and is yet to be part of the mainstream adult diet on a mass scale.The product mix and consumption pattern in India is unlikely to change drastically in the next few years. The largest demand will continue to be for processed cheese and cheese spreads. Children will continue to be the largest consumers of cheese. Of the predicted increase in demand, children will contribute to the largest proportion in tier 2 cities while it will be adults in the metros. To cater to this increase, it is also likely that cheese producers introduce new varieties of specialty cheese in the metros. 7. Observations 1. Increasing and Widespread Demand: Based on a multi-year study of dairy consumption patterns in China, Mckinsey predicts a growth in the demand for Cheese by 40% by 2011.With India having similar consumer trends- namely, growing incomes, westernization and urbanization – Indian demand is likely to mirror Chinese patterns. Two conspicuous outcomes are: i) There is likely to be a 25%-30% increase in demand in the metros and ii) There is likely to be a 5%-10% growth in demand in tier 2 cities as urbanization and modern consumption patterns extend to these cities. 2. Food technology improvements: In the next 3 years, regional players will be forced to adopt new technologies that enable the m to go national to survive. 3. Indianization of processed cheese: The next three years will see new Indian flavours of cheese being introduced in the processed cheese and cheese spread market.The Indian consumer has unique tastes with variations even across regions. Both Indian and International brands are likely to ‘Indianize' their cheese products with Indian flavours to attract a larger customer base. 4. Consolidation of Cheese Plants: The explosion of retailing in India will probably have a significant impact on the cheese industry. Large chains of supermarkets that have entered the country, like Tesco, would follow their global policies of tightening supplier margins that could put small cheese producers out of business. The supplier end will likely be dominated by huge national producers who can achieve sufficient economies of scale to be able to afford low margins.There will be a few such national cheese factories, supplying to various cheese marketers and retail chain s, who in turn brand cheese under their own labels. There is also a high probability that cheese importers like Kraft and Bel Fromageries begin domestic production to lower prices and increased availability of their products. 8. Summary The organised cheese industry in India is at best in its nascent stage, accounting for less than 1% of total dairy production and largely limited to urban consumption. The organized cheese industry in India as of 2006, is valued at Rs 250 crore (US$ 50 million), with a volume in excess of 8000 tonnes. The industry growth rate is estimated at about 10%-12% per year in terms of volume and 16%-17% per year in value terms.Current household cheese penetration is 5%, with about 50% of consumption being limited to cities. Mumbai and Delhi together capture half of the cheese market. Within cheese products, around 60% of the market is dominated by processed cheese, 30% by cheese spreads and the remaining 10% by flavoured and specialty cheese. Amul and Britann ia Milk Man are the lead brands. Overseas cheese producers are eyeing the Indian market for its huge promise. The explosion of retailing in India is expected to have its impact on the cheese industry also. This paper looks at the lead national and regional players as well as the consumption, production and marketing trends. 9. Key government contacts:Government Department| Responsibility| Contact Information| Ministry of Agriculture, Department of Animal husbandry, Dairying and Fisheries (DADF)| The Department is responsible for matters relating to livestock production, preservation, protection from disease and improvement of stocks and dairy development, and also for matters relating to the Delhi Milk Scheme and the National Dairy Development Board. | The Secretary,   Telephone:+91 11 23382608 Email: [email  protected] in| National Dairy Development Board (NDDB)| A government organization, NDDB is the apex body of State cooperatives. Also provides training and consulting servic es. | Head Office: P. B. No. 40 Anand – 388 001 Gujarat, INDIA Telephone: 91-2692-260148/260149/260159/260160 Fax: 91-2692-260159/260165 Email: [email  protected] coop|Ministry of Food Processing Industries| The main central agency of the Government responsible for developing a strong and vibrant food processing sector; with a view to create increased job opportunities in rural areas, enable farmers to reap benefit from modern technology, create surplus for exports and stimulate demand for processed food| The Joint Secretary,   Telephone: Ph. : 011-26492476 Fax: 011-26493228 Email: [email  protected] in| 10.References: www. themilkweed. com

Teachers and Standardized Testing Pressure

If youre in education in the 21st Century, were willing to bet you feel the pressure of standardized test scores, no matter where you teach in the United States. The pressure seems to come from all sides: the district, parents, administrators, the community, your colleagues, and yourself. Sometimes it feels like you cant take a moment away from the hard-core academic subjects in order to teach so-called non-essentials, like music, art, or physical education. These subjects are frowned-upon by the people who meticulously monitor test scores. Time away from math, reading, and writing is seen as time wasted. If it doesnt directly lead to improved test scores, you arent encouraged, or sometimes even allowed, to teach it. In California, school rankings and scores are published in the newspapers and discussed by the community. Schools reputations are made or broken by the bottom line, numbers printed in black and white on newsprint. Its enough to make any teachers blood pressure rise at the thought of it. What Teachers Have to Say About Standard Testing These are some of the things teachers have said over the years about standardized test scores and the pressures surrounding student performance: I did just fine in school and life, even though my teachers didnt emphasize achievement on tests.Its only one test - why does it matter so much?I dont even have time to teach Science or Social Studies any more!I start teaching Test Preparation the first week of school.Its not fair that were graded on how our students do on this test when all we can do is present the information to them. We cant help how they will actually do on Test Day!My principals on my back this year because my students didnt so well last year. This is just the tip of the iceberg when it comes to teachers opinions on this controversial issue. Money, prestige, reputation, and professional pride are all at stake. Administrators seem to be getting additional pressure to perform from the district bosses which the principals, in turn, pass down to their staff. No one likes it and most people think its all irrational, yet the pressure is snowballing and increasing exponentially. What Research Has to Say About Standard Testing Research shows that there is an incredible amount of pressure that is placed on teachers. This pressure often results in teacher burn-out. Teachers often feel like they need to teach to the test which results in them having to take away from higher order thinking skills, which has been proven to have long term benefits for students and is a much needed 21st-century skill. Edited By Janelle Cox